Objective: We investigated the effectiveness of a self-help intervention named PER-ANTARA, which aims to improve adherence to diagnostic procedures among women with breast cancer (BC) symptoms to reduce the time to a definitive diagnosis.Methods: With a cluster randomized crossover design across four hospitals, PER-ANTARA and treatment as usual (TAU) or TAU only was provided at successive periods in a randomly determined order. The main outcome was the time between the first medical consultation and the definitive diagnosis. Secondary outcomes were BC knowledge, measured by the Breast Cancer Knowledge Test (BCKT); symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS); quality of life, measured by the World Health Organization Quality of Life-BREF (WHOQOL-BREF); and health status, measured by the EQ-5D-5L. A linear mixed model analysis was conducted to analyse the outcomes. Results: We recruited 132 women with BC symptoms from four hospitals; 67 participants were in the intervention group, and 65 participants were in the control group. PERANTARA reduced the time to definitive diagnosis by 13.3 days (M [SD]: 25.90 [23.20] in the intervention group vs 39.29 [35.10] in the control group; mean difference = −13.26, 95% CI = −24.51 to −2.00, P = .02). No significant difference was found between the groups in BC knowledge, symptoms of anxiety, depression, quality of life, or health status. Conclusions: PERANTARA reduced the time to definitive diagnosis among Indonesian women with BC symptoms. Psychoeducation may be an important addition to regular BC care to prevent undue delays in diagnostic procedures. K E Y W O R D S adherence, breast, cancer, cluster randomized controlled trial, diagnosis, health education,

BackgroundBreast cancer (BC) is the most frequent cancer occurring in women across the world. Its mortality rate in low-middle income countries (LMICs) is higher than in high-income countries (HICs), and in Indonesia BC is the leading cause of cancer deaths among women. Delay in breast cancer diagnosis negatively impacts cancer prognosis. Only about 30% of patients who come to the hospital to check on their breast abnormalities, continue thorough examination to biopsy to get a diagnosis based on the results of anatomical pathology. Many Indonesian women with breast cancer were already in an advanced stage when starting treatment. Therefore, delay in diagnosis is a serious problem that needs to be addressed. The present study will investigate whether our newly developed self-help psycho-educational programme, “PERANTARA”, for women with breast cancer symptoms is effective to reduce patient diagnosis delay in Indonesia.MethodsA cluster-randomized controlled trial will be conducted in 106 patients in four hospitals in Bandung, West Java, Indonesia. Data will be collected at baseline (pre-assessment), 7 days after the intervention (post-assessment), and at 3 months (follow-up assessments). The primary outcome is delay in diagnosis and treatment. Secondary outcomes are breast cancer knowledge, anxiety and depression, and quality of life. Exploratively, adherence with treatment will be measured too. Data will be analysed by hierarchical linear modelling (HLM) to assess differential change over time.DiscussionIf proven effective, PERANTARA will be evaluated and implemented in a diversity of settings for local cares (such as in POSYANDU, PUSKESMAS) that provide health education/psycho-education for women with breast symptoms.Trial registration ISRCTN12570738. Date: November 19th, 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3268-7) contains supplementary material, which is available to authorized users.

Background:Delay in the diagnosis of breast cancer (BC) may lead to an advanced stage of the disease and a poor prognosis. A psychoeducational intervention can be crucial in helping women with BC symptoms complete the examination procedures and reduce diagnosis delay of BC.Objective:To develop a psychoeducational intervention to reduce the delay of BC diagnosis among Indonesian women with BC symptoms.Methods:The development of the intervention included an inventory of crucial elements in developing psychoeducation through literature review as well as consultation with BC patients and healthcare providers. Additionally, we developed PERANTARA as the first pilot version of the self-help guided psychoeducational intervention. PERANTARA is an abbreviation for “Pengantar Perawatan Kesehatan Payadura”, which means an introduction to breast health treatment. The pilot feasibility study combined an expert review and a pilot testing in hospital settings. A semi-structured interview and the client satisfaction inventory were utilized to measure feasibility and acceptability of the intervention for Indonesian women with BC symptoms.Results:PERANTARA contained an oncologist’s explanation about BC and the BC survivors’ testimony to reduce the time to diagnosis. The pilot study results showed that most patients were satisfied with and trusted on PERANTARA.Conclusion:PERANTARA was feasible and acceptable for Indonesian patients with BC symptoms. The development framework suggested in this study can be applied to develop psychoeducational packages for other patients group, in particular, those interventional packages aimed at reducing diagnosis and treatment delays and non-adherence.

Background: Breast cancer is the most common type of cancer that has been diagnosed among Indonesian women. One of the subtypes that frequently being studied is the triple negative breast cancer which has poorer prognosis among all subtypes. The objective of this study was to investigate the incidents and the characteristics of triple negative breast cancer patients. Methods: This study used triple negative breast cancer patients' medical records in Dr. Hasan Sadikin General Hospital. Some characteristics were identified, such as age at presentation, menopause status, tumor size, stage at presentation, grades of tumor, pathological features, and metastatic status. Data were taken during 2010 and 2011 and presented in table.Results: Thirty women among 252 patients were identified as having triple negative breast cancer. Based on those 30 cases, 11 patients were in the age group of 40-55 years. Fifteen out of 30 cases were premenopausal. From 30 cases, 14 patients had tumor size bigger than 5 cm. Sixteen cases had stage III tumor. Most of the cases were invasive ductal carcinoma mammae as their histological features. Two cases had metastized to pleura. Conclusions:The incidence rate of triple negative breast cancer in Dr. Hasan Sadikin General Hospital is 11.9% with these common characteristics: range of age are between 40 to 45 years, have a premenopausal, had >5cm tumor , stage III tumor and has histological feature IDC, and only 2 patients were metastized to pleura. [AMJ.2015;2(3):391-94]

Background: Breast cancer education could be a non-formal education to achieve a proper understanding about early detection of breast cancer. Optimal results need right methods and instruments. Recently, technology development can be implemented to support the non-formal education process. The purpose of this study was to determine the effectiveness between print and audiovisual media in health education on prevention and early detection of breast cancer. Methods: It was a quasi-experimental study, comparing two intervention and one control groups, which was carried out from August to November 2013. The population was senior high school students in Jatinangor subdistrict West Java, Indonesia. The sample was taken by cluster sampling method; each group consisted of 120 female students. Students from Sekolah Menengah Atas Negeri Jatinangor were given printed media, students from Sekolah Menengah Kejuruan Padjadjaran were given audiovisual media and students from Pesantren Al Ma'soem as control group were not given any intervention. The knowledge of respondents was measured with pre-test and post-test questioner. Mean scores of knowledge were further analyzed by paired and independent t-test. Results: The average of pre-test between intervention and control groups were similar (8.125, 8.725 and 8.450, respectively). The result showed that the average scores of post-test increased compared to pre-test both in the print and audiovisual media group (p=0.001). Conclusions: Print and audiovisual media can increase the knowledge of respondents on prevention and early detection of breast cancer. However, audiovisual media is more effective as a tool for health education especially among teenagers.